OBJECTIVES: Retropharyngeal abscess in adults can be life-threatening. The otolaryngologist is on the front line in making the diagnosis and treatment of this disease. The aim of this study is to review ... [more ▼]

OBJECTIVES: Retropharyngeal abscess in adults can be life-threatening. The otolaryngologist is on the front line in making the diagnosis and treatment of this disease. The aim of this study is to review the clinical features, the diagnostic tools and the management of retropharyngeal abscesses in adults. PATIENTS AND METHODS: Retrospective study of retropharyngeal abscesses in adults admitted in the ENT department from 2005 to 2010. RESULTS: In total 4 patients were included in this study: mean age of 53 years (range 45 to 62 years), sex ration F/M = 3. Cultures obtained from the abscesses identified group A beta-hemolytic streptococci susceptible to amoxicilline-clavulanate in three cases. The treatment consisted in surgical drainage of the collection and intravenous antibiotics. CONCLUSIONS: Retropharyngeal abscesses in adults are critical infections requiring prompt diagnosis and treatment. Computed tomography scan was the crucial tool for the diagnosis, notably to differentiate cellulitis from abscesses. The management includes intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess. The outcome is usually good. [less ▲]

The present study is the outcome of 5 former studies aiming at the adaptation of the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singer, dysodic or not. The ... [more ▼]

The present study is the outcome of 5 former studies aiming at the adaptation of the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singer, dysodic or not. The reliability, validity and internal coherence was evaluated on a population of 192 classical singers and 27 non singers. The comparison of the mean scores at the test and the retest shows that the results at the retest are significantly inferior for the functional scale (p=0.013) and for the global score (p=0.006). The test/re-test stability is good (ICC : Functional scale (F) : 0.869, Emotional scale (E) : 0.846, Physical scale (P) : 0.85, Global score (G) : 0.878/ Spearman’s rho F : 0.855, E : 0.834, P : 0.858, G : 0.886). The internal coherence of each sub scale is good (Cronbach’s alpha : >0.80). The correlation between the 3 subscales is quite high (FvsE : 0,613 /EvsP : 0,737/ FvsP : 0,693) which means that each scale measures a specific dimension but that they are still homogeneous. The test/re-test difference between the singers and the controls are not significant but the control group has a greater variability in their answers (Levene test : F : p<0 .001; P : p=0.009 ; G : p=0.02). Three variables increase the results : being a solist (F : p=0.046; E : p=0.002; P : p=0.056; G : p=0.006), being an amateur (F : p<0.001; E : p=0.019; P : p<0.001; G : p=0.001), having a vocal complaint (F, E, P et G : p<0.001). In conclusion, this version of the V.H.I is reliable, valid and adapted to the population of classical singers. [less ▲]

Communication présentée lors du LXIième congrès de la Société Française de Phoniatrie et des Pathologies de la Communication; Paris, le 9 octobre 2005. Our knowledge of vocal fold structure has profoundly evolved since the description by M.Hirano in 1974 of the laminar organization of the connective tissue of the human vocal fold , the lamina propria. The molecular composition of the extracellular matrix (ECM) of the lamina propria is essential in determining the viscoelastic properties of the tissue. This is particularly true in the superficial layer of the lamina propria ( also called Reinke’s space). With the epithelium, Reinke’s space constitutes the vocal fold main vibrator. In normal subjects, the jelly like structure of the Reinke’s space is due to a very loose fibrous scaffolding and to a balance between the interstitial proteins of the ECM : proteoglycans like decorin and hyaluronic acid and glycoproteins like fibronectin. Vibratory trauma leads , in disease states , to molecular modification of the extracellular matrix of Reinke’s space resulting in benign cordal lesions like nodules, submucosal fibrosis and vocal folds scars. Improving the knowledge of the homeostasis of Reinke’s space ECM can lead to improvement of the therapeutic and prevention strategies of vocal fold benign lesions. The main histologic and viscoelastic characteristics, as well as surgical treatment of cordal nodular lesions and scars are described. The recent researches in the field of regeneration of Reinke’s space are evoked. Rappel des connaissances de la microstructure cordale normale( et en particulier de la structure laminaire de la corde vocale ainsi que la répartition particulière des protéo- et glycosaminoglycans) , de l'altération de celle-ci en cas de nodule cordal et de cicatrice cordale. Implications thérapeutiques en terme de technique microchirurgicale, en particulier implantation d'acide hyaluronique estérifié dans la plaie microchirurgicale afin de moduler le processus de cicatrisation [less ▲]

OBJECTIVES: The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's ... [more ▼]

OBJECTIVES: The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's reliability and coherence. In order to obtain this first scale, we went through three stages. MATERIAL ET METHOD: The first consisted in the modification of the existing items and the creation of new ones. The second was to measure the stability by a test - retest and the coherence of the adapted and the new items. This was done on groups of dysodic singers and professional voice users. The third stage consisted in evaluating the reliability and the coherence of 31 items on a homogeneous population of 132 classical singers with and without vocal impairment. The subjects were divided in three groups. The first group was composed of 95 normophonic singers, the second included 37 dysphonic singers and the third group was the control group, composed of 20 non singers without vocal complaints. RESULTS: The statistical results show a good stability of the test - retest (ICC=0.949; Rho: 0.912; Bland et Altman [-010.19, +13.23]). The internal coherence of each sub scale (Cronbach's alpha) is good (>0.70). The correlations between the three sub scales are moderate between the functional and the emotional sub scale: 0.58; between the emotional and the physical: 0.64; and between the functional and the physical: 0.78). Each sub scale is measuring a specific dimension; still they are homogeneous between one another. Four variables have a significative influence on the results: the pathology (p<0.001), being a professional singer (p<0.001), the repetition (p=0.003), being a chorister (p=0.002). CONCLUSION: The VH.I adapted to the singers, appears to be reliable, valid and adapted to the population of dysodic classical singers. [less ▲]

Experts in voice singing and voice training were asked to judge the vibrato of 30 singers (4 samples per singer: a sung [a] held without vibrato; a sung [a] with vibrato; a self selected passage and an ... [more ▼]

Experts in voice singing and voice training were asked to judge the vibrato of 30 singers (4 samples per singer: a sung [a] held without vibrato; a sung [a] with vibrato; a self selected passage and an imposed passage. In the first part, they ticked the type of oscillations (vibrato, straight tone, tremolo, quavering, ...). In the second part, they appraised various criteria. Intra-judge and inter-judge consistencies were determined. The subjective parameters were thereafter correlated with the measurements of six parameters of the MDVP (Multi Dimensional Voice Program). The measurements were carried out on each task. Intra-judge consistency was good for only one judge (67-87% consistency). Since jdge 2 and 3 were hardly reproducible (45-73%; 28-57%) measurement of the inter-judge consistency was pointless. The results of jusge 1 were correlated with the Fundamental Tremor, Frequency Index, the jitter and the shimmer. [less ▲]